影响危重症颅脑损伤患者住院期间发生静脉血栓栓塞症的危险因素及风险预测模型构建  

Risk factors affecting venous thromboembolism in patients with critical brain injury during hospitalization and the construction of a risk prediction model

作　　者：蔡琳[1] 潘传亮[1] 张川[1] 王中[1] 马轶[1] 谭颜汭 余红[1] CAI Lin;PAN Chuanliang;ZHANG Chuan;WANG Zhong;MA Yi;TAN Yanrui;YU Hong(Department of Intensive Care Medicine,Chengdu Third People's Hospital,Chengdu,Sichuan 610031,China)

机构地区：[1]成都市第三人民医院重症医学科,四川成都610031

出　　处：《中华神经外科疾病研究杂志》2025年第2期77-82,共6页Chinese Journal of Neurosurgical Disease Research

基　　金：四川省自然科学面上基金项目(2024NSFSC0488)。

摘　　要：目的探讨影响危重症颅脑损伤患者住院期间发生静脉血栓栓塞症(VTE)的危险因素并构建风险预测模型。方法选取2021年9月至2024年8月成都市第三人民医院收治的202例危重症颅脑损伤患者作为本次研究对象,根据住院期间是否发生VTE分为VTE组(n=44)和非VTE组(n=158)。采用二分类Logistic逐步回归分析探讨危重症颅脑损伤患者住院期间发生VTE的影响因素,并以此构建列线图模型;采用受试者工作特征(ROC)曲线评估列线图模型对危重症颅脑损伤患者住院期间发生VTE的预测价值。结果VTE组年龄≥60岁、合并糖尿病、合并多发伤、有深静脉置管所占比例均大于非VTE组,手术时长、住院时间长于非VTE组,D-二聚体水平高于非VTE组,入院时格拉斯哥昏迷量表(GCS)评分、血小板计数、凝血酶原时间(PT)小于非VTE组(P<0.05)。多因素分析显示,年龄≥60岁(OR=2.408,95%CI:1.618~3.585)、合并糖尿病(OR=2.499,95%CI:1.672~3.735)、入院时GCS评分低(OR=0.325,95%CI:0.211~0.501)、合并多发伤(OR=2.008,95%CI:1.422~2.835)、有深静脉置管(OR=2.147,95%CI:1.488~3.097)、D-二聚体水平升高(OR=2.724,95%CI:1.784~4.159)是危重症颅脑损伤患者住院期间发生VTE的独立危险因素(P<0.05)。构建预测危重症颅脑损伤患者住院期间发生VTE的列线图模型,结果显示,一致性指数(C-index)为0.817(95%CI:0.765~0.869)。列线图模型预测危重症颅脑损伤患者住院期间发生VTE的曲线下面积(AUC)(95%CI)为0.884(0.832~0.936),特异度为68.44%,灵敏度为91.82%。结论危重症颅脑损伤患者住院期间发生VTE的危险因素包括年龄、合并糖尿病、入院时GCS评分、合并多发伤、深静脉置管、D-二聚体,据此构建的列线图模型对危重症颅脑损伤患者住院期间发生VTE具有较高的预测价值。Objective To explore the risk factors of venous thromboembolism(VTE)in patients with critical brain injury during hospitalization and to establish a risk prediction model.Methods 202 patients with critical craniocerebral injury from September 2021 to August 2024 were selected as the subjects of this study.According to VTE occurrence during hospitalization,they were divided into VTE group(n=44)and non-VTE group(n=158).Factors affecting the occurrence of VTE in patients with critical craniocerebral injury during hospitalization were investigated by Binary Logistic stepwise regression,and a nomogram model was constructed.The value of the nomogram model in predicting VTE during hospitalization in patients with critical brain injury was evaluated by ROC.Results The proportion of patients in VTE group with age≥60 years old,diabetes mellitus,multiple injuries and deep venous catheterization was higher than that in non-VTE group,with their operation duration and hospital stay longer than those in non-VTE group,their D-dimer level higher than that in non-VTE group,and their GCS score,platelet count and PT on admission lower than those in non-VTE group(P<0.05).Multivariate analysis showed that age≥60 years(OR=2.408,95%CI:1.618-3.585),combined diabetes(OR=2.499,95%CI:1.672-3.735),low GCS score on admission(OR=0.325,95%CI:0.211-0.501),multiple injuries(OR=2.008,95%CI:1.422~2.835),deep venous catheterization(OR=2.147,95%CI:1.488-3.097),and elevated D-dimer level(OR=2.724,95%CI:1.784-4.159)were independent risk factors for VTE in patients with critical brain injury during hospitalization(P<0.05).A nomogram model was then constructed to predict the occurrence of VTE in patients with critical craniocerebral injury during hospitalization.The results showed that the consistency index(C-index)was 0.817(95%CI:0.765-0.869).The area under the curve(AUC)(95%CI)was 0.884(0.832-0.936),the specificity was 68.44%,and the sensitivity was 91.82%.Conclusions The risk factors for VTE in patients with critical brain injury during hospitaliz

关 键 词：颅脑损伤 静脉血栓栓塞症 危险因素 列线图 预测模型 

分 类 号：R651.15[医药卫生—外科学]